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Med Surg > Fluid & Electrolytes > Flashcards

Fluid & Electrolytes Flashcards

1
Q

Fluid therapy for a 16-year-old female trauma patient who has head trauma and suspected cerebral edema following an automobile accident. Would you give Albumin OR Mannitol?

A

Mannitol: Mannitol is an osmotic diuretic that decreases cerebral edema. Albumin is a protein that draws fluid into the vascular space and would make cerebral edema worse.

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2
Q

Fluid therapy for a 22-year-old female patient who is pregnant and admitted with hyperemesis gravidarum after vomiting for the last seven days. Would you give Colloid OR Cyrstalcolloid?

A

Crystalcolloid: The use of colloid therapy would be contraindicated because fluid would pull from the extravascular to the intravascular space. Instead you want to rehydrate the cells

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3
Q

Fluid requirement for a 58-year-old male patient admitted with hypokalemia who requires intravenous potassium replacement therapy. Give K+ IV bolus OR K+ IV solution?

A

K+ IV Solution: Potassium replacement therapy is considered a high-alert medication and should never be administered as an IVP bolus, which could cause dysrhythmias and cardiac arrest

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4
Q

Fluid replacement therapy for an 80-year-old male patient who is hypotensive. Would you give 3% NS or NS?

A

NS: An isotonic fluid would be indicated for replacement therapy for a hypotensive elderly patient to fill the vascular space. Three percent normal saline is a hypertonic solution and would cause fluid shifting and worsen cellular dehydration.

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5
Q

Fluid replacement for an 18-year-old male patient with a normal blood pressure, experiencing leg cramps after completing a marathon. Would you give Hyper OR Hypo tonic solution?

A

Hypo: A hypotonic solution shifts fluid out of the vessels into the cells, which improves the dehydration causing the leg cramps

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6
Q

Treatment for a 45-year-old in hypovolemic shock from blood loss after a gunshot wound. Would you give Albumin OR Mannitol?

A

Albumin: Albumin expands the vascular space and is not contraindicated in bleeding disorders. Mannitol is an osmotic diuretic and will cause additional fluid loss.

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7
Q

Fluid replacement for a 28-year-old female with severe hyponatremia and low blood pressure from adrenal insufficiency and a lack of aldosterone. Would you give Iso OR Hyper tonic solution?

A

Hyper: A hypertonic solution will increase serum sodium levels while shifting fluid into the circulation and creating vascular expansion, thereby raising the blood pressure. An isotonic solution would not correct the hyponatremia, only the low blood pressure.

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8
Q

Sodium

A

135-145 mEq/L

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9
Q

What disorder: HA, Lethargy, Confusion, Seizure, N/V, coma, Neurological symptoms

A

Hyponatremia

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10
Q

What disorder: Irritability, hypotension, Shallow respirations, Hyperexcitability, Tetany

A

Hypochloremia

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11
Q 
What disorder caused by: 
Metabolic alkalosis
NG suctioning
Addison's disease
Severe burns
Respiratory acidosis
A

Hypochloremia

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12
Q

Chloride

A

97-107 mEq/L

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13
Q

Potassium

A

3.5-5 mEq/L

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14
Q

What disorder caused by:
Renal failure, Metabolic acidosis
Soft tissue injury

A

Hyperkalemia

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15
Q

What disorder: Generalized fatigue, muscle cramps

Bradycardia, ventricular dysrhythmias

A

Hyperkalemia

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16
Q

What symptoms will you see if K+ is greater than 6 mEq/L

A

Narrow and peaked T wave
ST depression
Shortening of ST interval

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17
Q

What symptoms will you see if K+ is 6.5-7.5 mEq/L

A

Lengthening of PR interval, QRS and QT interval
Decrease in amplitude of R wave
Increase depth of S wave

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18
Q

What lab do you want to order for hyperkalemia?

A

BUN
Creatinine
Glucose levels

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19
Q 
What disorder caused by:
Bicarb loss through renal and GI systems
FVE
Hypernatremia
Metabolic acidosis
A

Hyperchloremia

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20
Q

What disorder: Thirst, coma, seizures, agitation, restlessness, neuromuscular irritability

A

Hypernatremia

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21
Q 
What disorder: Deep rapid respirations
Lethargy
Tachypnea
Decrease LOC
Hypertension
A

Hyperchloremia

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22
Q

What disorder caused by: Gastric suctioning, excessive use of enema, laxatives, or diuretics, hypernatremia

A

Hypokalemia

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23
Q

Never give __ IV ___

A

K+ IV push

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24
Q

What disorder: palpitations, N/V, weakness, lethargy

A

Hypokalemia

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25
Q

Magnesium

A

1.6-2.2 mEq/L

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26
Q

Magnesium alters effects of __

A

Ca+

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27
Q

What disorder: tetany, hyperactive reflexes, tremors, Trousseau and Chvosteks, vertigo, high BP and HR, v tach, seizures

A

Hypomagnesemia

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28
Q

Interventions for Hypermagesemia

A

Iv hydrations

Loop diuretics

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29
Q

What disorder: Hypotension, arhythmias, loss of deep tendon reflexes, coma, bradycardia

A

Hypermagnesemia

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30
Q

Calcium

A

8.2-10.2 mg/dL

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31
Q

Ionized calcium

A

4.6-5.3 mg/dL

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32
Q

What is calcium regulated by?

A

Thyroid and Parathyroid

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33
Q

Increase in PTH = __

A

Increase in calcium

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34
Q

Increase in calcitonin = __

A

Decrease in calcium levels

35
Q

Lithium toxicty causes what disorders?

A

Hypermagnesemia

Hypercalcemia

36
Q

What disorder caused by: Alcohol abuse, malnutrition, chemotherapy, hypokalemia, hypocalcemia

A

Hypomagnesemia

37
Q

What disorder: Excitability of nerves and muscles, muscle spasms, dysphagia, wheezing, bronchspasms, trousseau and Chvostek

A

Hypocalcemia

38
Q

Interventions for hypocalcemia:

A

IV Calcium gluconate

39
Q

Intervention for hypercalcemia:

A

NS IV
Loop diuretic
IV biphosphates
Calcitonin

40
Q

What disorder caused by: malignancies, hyperparathyroidism, lithium, thiazide diuretics, and excessive vitamin A and D

A

Hypercalcemia

41
Q

Phosphorus

A

2.5-4.5 mEq/L

42
Q

Phosphorus has a ___ relationship with calcium

A

Inverse

43
Q

Hypophosphatemia is similar to ___

A

Hypercalcemia

44
Q

What disorder caused by: Burns, DKA, excessive antacid use

A

Hypophosphatemia

45
Q

Treatment for hypophosphatemia:

A

Oral/IV Phosphorus

TPN/enteral feeding for dysphagia pt.

46
Q

Tx for hyperphosphatemia

A

Phosphate binders
IV NS
Loop diuretics

47
Q 
What disorder:
Hyperreflexia
Soft tissue calcification
Convulsions
Bone/joint pain
A

Hyperphosphatemia

48
Q

Hyperphosphatemia is similar to:

A

Hypocalcemia

49
Q

What disorder: Confusion, tremor, joint stiffness, bone pain, muscle weakness

A

Hypophosphatemia

50
Q

NS

A

Isotonic

51
Q

D51/2NS

A

Hypertonic

52
Q

D5W is ___ outside the vascular space but __ inside the vascular space

A

D5W is Isotonic outside the vascular space but Hypotonic inside the vascular space

53
Q

1/2 NS

A

Hypotonic

54
Q

What pt. should you use D51/2NS cautiously in?

A

CHF
Renal failure
Liver failure

55
Q

You should NEVER admin hypotonic solution to what kind of pt.

A

Burn pt or Pt. w/ increase ICP

56
Q

Pt. with cerebral edema needs what kind of IVF?

A

Hypertonic

57
Q

What pt. needs hypotonic solution?

A

DKA

HHS

58
Q

What is a potential complication when administering a hypertonic solution?

A

Fluid volume overload

Hypernatremia

59
Q

What is a potential complication when administering a hypotonic solution?

A

Worsening hypotension

Increase edema

60
Q

What is a potential complication when administering a Isotonic solution?

A

Fluid overload

Generalized edema

61
Q

What is a potential complication in a pt. with FVD?

A

Hypovolemic shock

62
Q

Tx for FVD:

A

PO fluids

IV replacement: NS

63
Q

What is a potential complication in a pt. with FVE?

A

Pulmonary edema

64
Q

Tx for FVE

A

Correct underlying cause
Terminating/decreasing IVF
Diuretics
Renal dialysis (renal failure pt.)

65
Q

Lab for FVE

A

Hematocrit
BUN
Serum osmolality
Albumin (hypoalbumin present in cirrhosis)

66
Q

Lab for FVD

A 
Hemoglobin
Hematocrit
Serum osmolality
Creatinine
Specific gravity
67
Q

The nurse is caring for a patient with a potassium level of 2.8 mEq/L. Which assessment change related to this is most concerning?

a. ) lightheaded
b. ) tremors
c. ) bone/joint pain
d. ) palpitations

A

d.) Palpitations: pt. at risk for lethal dyrhythmias

68
Q

Pt. with lab values: (K+ 5.1) (Na+ 128) (Mg 1.5) (Ca+ 8.0)
Phos 4.7) (Cl- 96) Priority action:
a.) Pad bedrails and set up suction
b.) Contact provider
c.) Assess for Tousseau and Chvostek
d.) Encourage oral fluids and monitor I and O

A

a.) Pt. with hyponatremia is at risk for neurological disorientation and can lead to seizures

69
Q

The nurse is caring for a patient with celiac disease who lacks vitamin D absorption. What conclusion can the nurse make with this assessment finding?

a. ) Pt. severely dehydrated
b. ) Normal findings
c. ) Mag level high
d. ) Calcium level low

A

d.) Lack of vitamin D absorption or intake will decrease calcium levels

70
Q

The nurse is admitting a patient with confusion and hallucinations. The laboratory report shows hyponatremia, normal potassium, hypomagnesemia, and hypocalcemia. What priority actions should the nurse take? Select all that apply.

a. ) Neurological assessment
b. ) Assess for irregular pulse
c. ) Implement fall precautions
d. ) Determine how much alcohol pt. drinks
e. ) Evaluate for tremors and muscle weakness

A

A, B, C, D, E

71
Q

he nurse is assessing a patient with a positive Chvostek’s sign. Which actions are a priority? Select all that apply

a. ) Assess lung sounds
b. ) Request soft diet
c. ) Evaluate phosphorus levels
d. ) Assess for clots
e. ) Monitor BP and HR

A

A, B, C

Request soft diets: hypocalcemia can cause difficulty swallowing determine if aspiration risk

72
Q

A nurse assessing a patient recovering from surgery notices an increased thirst, urine output, and the inability to swallow. The patient’s laboratory report indicates a serum magnesium level of 1.4 mEq/L. What treatment should the nurse request from the healthcare provider?

A

Mag replacement

73
Q

The nurse is caring for an older adult who is unable to swallow and receiving a hypertonic nutritional supplement through an enteral tube. The nurse notes that the laboratory report shows hypernatremia. What action should the nurse take?

A

Monitor weight and Na+ levels: because receiving hypertonic feedings could cause water retention (weight gain) and hypernatremia

74
Q

The nurse is caring for a patient with adrenal cortex insufficiency (Addison’s disease) with a lack of aldosterone production. Which electrolyte should the nurse monitor most closely?

A

Sodium
Aldosterone release causes an increase of sodium. When there is a lack of aldosterone there is a lack of sodium. Additionally K+ will increase

75
Q

The nurse is caring for a patient in metabolic acidosis with a potassium level of 6.0 mEq/L. What is the nurse’s priority action?

a. ) EKG monitor
b. ) Obtain baseline weight
c. ) Deliver spironolactone
d. ) Assess LOC

A

a.) EKG monitor

76
Q

Foods high in K+

A 
Fruits
Potatoes
Tomatoes
Avocados
Instant coffee
Molasses
Brazil nuts
Banana
Spinach
Cantaloupe
77
Q

Foods high in Ca+

A 
Dairy products
Canned fish with bones
Broccoli/Kale
Oranges
Eggs
Requires vitamin D for best absorption
78
Q

Foods high in Mg+

A 
Dark green leafy vegetables
Whole grains
Chocolate pudding, milk, bars
Cashews, Almonds, Peanuts
Mg2+-containing laxatives and antacids
79
Q

Foods high in Phos

A

Milk
Processed foods meats
high-protein foods
Cheese and other dairy products

80
Q

Foods high in Na+

A 
Potato chips
Tomato soup/salsa
Frozen vegetables
Salad dressings
Canned Foods
Processed foods
81
Q

What type of pt will you use caution when giving LR?

A

Renal pt. because contains electrolytes

82
Q

Hypotonic fluids can cause vascular ___

A

Dehydration

83
Q

What is normal urine output?

A

30 mL/hr

Med Surg (22 decks)

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